A hospice doctor’s advice on financial independence and living a regret-free life [PODCAST]

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“Unlike my dad, I grew up with very different feelings about my own longevity. I have always believed that I would live to a ripe old age. This belief has colored my approach to career and finances. In many ways, I was able to delay my passions in order to build the appropriate amount of jet fuel to power my transatlantic flight. The urgency of now was replaced with a wholehearted wish to delay gratification now to benefit the future.

Getting your financial house in order requires understanding these concepts, weighing them, and coming to terms with what scares you most. Armed with this knowledge you can create a financial plan which balances the urgency of now and your wealth needs for the future.”

Jordan Grumet is an internal medicine physician, host of the Earn & Invest Podcast, and author of Taking Stock: A Hospice Doctor’s Advice on Financial Independence, Building Wealth, and Living a Regret-Free Life.

He shares his story and discusses his KevinMD article, “A hospice doctor’s advice on getting your finances in order.”

This episode is sponsored by the American College of Lifestyle Medicine (ACLM). 

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Go to lifestylemedicine.org/membership to learn more.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/follow. Today on the show we have Jordan Grumet. He’s an internal medicine physician. His latest book is Taking Stock: A Hospice Doctor’s Advice on Financial Independence, Building Wealth, and Living a Regret-Free Life. I’ve known Jordan since 2005, an old friend from the health care social media space. Wonderful to have you on, Jordan.

Jordan Grumet: Thank you for having me.

Kevin Pho: Yeah, I can’t believe how long we’ve actually known each other through the space. It’s been a long time, and it’s been a tremendous evolution, not just in the space itself but in you and me as well. I’m interested in hearing more about your story and journey to where you are today.

Jordan Grumet: Well, my story probably started when I was seven years old. My father was an oncologist, respected in society, and he ended up having a brain aneurysm. He got a headache one day and then died within 24 hours. Being seven years old, I somehow thought that was my fault, so I wanted to be a doctor just like him. I wanted to fill his shoes, and that was really my identity growing up. I went to high school and college. I studied like a madman. I taught myself how to learn everything in the book, just as all of us medical people do, and I was so excited when I got to residency and started being a doctor.

But over the years, as so many of us have, I became burned out: the long hours, the feeling like sometimes you just weren’t helping people, the paperwork, the administration, the rules, the things that seem to thwart us every time we’re trying to do our very best for our patients. When I was in the midst of my worst burnout, I started looking for ways out of medicine, and I discovered the financial independence movement. I looked at my finances, and thank God, because I had parents who modeled great financial information for me, I had enough money to significantly slow down in medicine or even stop.

That was about 2014, 2015, and the next bunch of years were a journey for me to figure out really what I wanted to do with my time, now that I didn’t have to fill it being a doctor. Were there parts of being a doctor that still had meaning? And if I wanted to step outside of that physician persona, who am I, and what should I do with my life now?

Kevin Pho: So many other physicians I talk to on this show and on my blog talk about the same obstacles that you describe, whether it’s the administrative burden or all the factors that lead to their own burnout. But you’ve actually taken that next step. You’ve actually stepped away from clinical medicine. You’ve written, obviously, the book. You’re doing what you love. Why have you taken that next step, whereas so many other doctors always talk about it but are hesitant to do so?

Jordan Grumet: When I started getting burned out in medicine, I started looking for the answer of how I could pull away and spend some time doing things that were more meaningful, and everywhere I turned, the answer was, “You don’t have enough money.” I went to my financial advisor, and he did a bunch of calculations. He said, “You just don’t have enough money to slow down. You need to keep working.” I went to my accountant, who was my mother at the time, and she said, “You need 10 million dollars.” I didn’t have 10 million dollars. I didn’t feel I could stop.

In 2014, this guy Jim Dahle, the White Coat Investor, sent me his book under the same name, and after reading it, I realized that I actually had, quote unquote, enough, enough fuel to start thinking about the things I really wanted to do with my life instead of what I had to do to make money. While this should have been very joyful, it actually gave me a panic attack, and I was really depressed for a bunch of months, because I realized that I’d spent so much time building up this identity, this persona of being a physician, that now that I could step away from something that wasn’t making me happy anymore, I had no idea who I really was. What is purposeful in life? What should I do with myself?

It would have been much easier to just go back to doing medicine and say, “This stuff is really too hard to think about. I don’t want to stress.” Instead, I did a deep dive into my identity and my purpose, trying to figure out what it is that I really want to do with life. I realized there were all these things that I was doing that I loved, but I was doing them on the periphery, because I thought I couldn’t do those for a living, or I certainly thought I didn’t have enough time because I was busy being a doctor. You and I were blogging back in 2004, 2005 about medicine, but I did it on nights and weekends and in spare time. It never occurred to me that this thing that I was passionate about, I could spend more time doing. When I realized that I had enough money where I could cut back on work, that was kind of the first place I went.

I think the reason why most people don’t do this is because we spend so much time thinking about career achievements and money that most of us don’t actually spend the time thinking about who we are and what is purposeful in our lives. It can be very, very hard work, and it is the kind of thing where, once we do it, we realize life is finite and I might not reach my goals. That’s real scary work to do, so a lot of us stay away from that. We go for the low-hanging fruit, which is some net worth number, or some promotion, or owning a private practice, or having a certain number of employees. All that stuff is great, but we kind of forget that money is more a tool to get what we really want in life instead of a goal. So I think a lot of us stick with that goal of achievement and money and forget that it’s just a tool for us to actually do other things that are important to us.

Kevin Pho: You talked about disconnecting yourself from that physician identity, and I think that’s something that a lot of physicians can relate to, because it’s a pretty linear path to become a physician, right? Now, walk us through that process, because you said it was very difficult, and I can imagine it’s very difficult after spending 20, 25 years doing the same thing and walking that straight path. Any deviation from that path, I can imagine, would be very difficult. So walk us through that. How did you overcome that obstacle to disassociate yourself from that physician identity?

Jordan Grumet: This was very difficult work for me, not just because I had worn that identity on my outside for all those years, as you talked about, but also because it was the last wisp of my connection to my father, who died when I was a little boy. So it was a very emotional transition, and it took years. It took years of journaling and thinking deeply about what was important to me.

The other thing is, I didn’t throw the baby out with the bathwater. When I realized that I had some financial space in my life, instead of walking away from medicine, which I think would have led to way more disruption in my life, I started looking really closely at what I was doing day to day, and I slowly started to subtract out the things in the workplace that I didn’t like, the things that were giving me friction. I owned my own concierge practice, where I saw patients at home, which I loved, but I was getting calls on Friday night and rushing out first thing Saturday morning to see sick patients in their homes. So the first thing I did is I dropped my concierge practice, and I did only nursing home work. Then I had some side hustles as medical director of nursing homes, as well as doing some hospice work.

I did that for another year too, and I’m like, “Wow, nursing home patients are stressful.” You’re always getting these late-night calls at three o’clock in the morning, trying to figure out whether to send someone to the emergency room or not. So eventually I got rid of the nursing home stuff, and I started doing hospice on a more full-time basis, because that was what I really liked. But I started thinking there are some things I’m interested in. I knew I liked writing. I knew I liked public speaking. And so I started just pulling away from hospice. I said, “Well, I’m not going to do nights anymore. I’m not going to be on call anymore. I’m not going to do weekends anymore.”

What I was left with was a position being a consultant to the hospice. They didn’t employ me; I was a consultant, and I managed a few teams, and I didn’t even do much patient work. I was more working with the teams to help them manage patients. There are Medicare regulations: You need to have a physician write a note a certain number of times per month for hospice patients. So here I could teach the nurses. I could help the CNAs and the chaplains and social workers. When there was a high-level problem, I could come in for family meetings and really try to help them through those difficult moments. This really had meaning for me, and I realized I would do this kind of work even if I wasn’t being paid for it, and that was a big aha moment.

So instead of throwing away that physician identity completely, I whittled it down to the things that were most purposeful for me, and that was hospice work. So I knew I had to keep that, but on the other hand, that gave me a huge amount of space in my life to start running a bunch of mini experiments about what feels purposeful and meaningful for me. My book actually is partially about this idea of how we find purpose. For me, working with hospice patients really clued me into this idea that when you get to your deathbed, often people will say things like, “I really regret I never had the energy, courage, or time to,” and kind of whatever comes next is their sense of purpose. So I started asking myself that question earlier. I’m like, “If I were on my deathbed, what kind of things would be purposeful for me that I’d regret not doing?” And I started trying those things, because I now had more space to try them.

Kevin Pho: And yes, your book is titled Taking Stock: A Hospice Doctor’s Advice on Financial Independence, Building Wealth, and Living a Regret-Free Life. And Jordan, I can safely say you’re probably the only person in the world who could write a book like this, taking your experience in hospice medicine and applying it to financial independence. Obviously, those are two very unlikely topics that you’re connecting in this book. You touched upon this earlier, but take us a little bit deeper. What are some of the connections between personal finance, financial independence, and a hospice physician?

Jordan Grumet: I came to financial independence at a time when I had already met my net worth goals. I had no idea what it was. I read Jim Dahle’s book, and all of a sudden I’m like, “Oh, I’m there.” So my interests weren’t necessarily in how do I manage my finances, how do I set up a 401(k), how do I do a Roth IRA, how do I invest. Those were kind of things I had a basic understanding of. But what I realized when I entered this community is there are a lot of people who figured the money part out, right? Because the money part is relatively simple. Not always easy, but it’s simple. We know the path we’re supposed to take, even if it’s hard work to get there. But I saw a lot of people floundering on the point of, “OK, I’ve got my money figured out, but what the heck do I do with my life now?”

And so I started a podcast called Earn and Invest, where that was really the central focus, this personal finance 201: Now you know how to make the money; what are we going to do now with our lives? And I was interviewing expert after expert about this idea. But on the other side, in my medical life, I was doing more and more hospice work, and I was sitting with patients and hearing them talk about their regrets. And guess what? None of my hospice patients said, “I regret that I didn’t work more nights and weekends.” None of them said, “My goal was a net worth of a million dollars, and I only made it to 500,000.” We didn’t have those conversations. We had conversations about meaning and purpose and experiences and people and the things they really wanted to do but never had the courage to try.

And it just clicked in my mind. I said, “I’m having these financial conversations, and I’m having these hospice conversations, and wow, couldn’t the financial people really learn something from the regrets of the dying?” I mean, the dying have this interesting thing where we tell them, “OK, you have four to six months to live,” and all the BS that clouds our mind, all those things that society tells us we’re supposed to be or we think we’re supposed to do, when you get a terminal diagnosis, all of that kind of fades away, and you start thinking about what you truly want.

And so I wanted to take all that knowledge and experience and bring it to young people. Maybe we could start having these conversations in our 20s and 30s. Maybe we could start figuring out purpose and identity before we built our financial framework, and then build our financial framework around those things, so that not only did we enjoy life once we were retired, but we could start enjoying it right now. We could start working to those important life concepts today, as opposed to waiting until sometime later, when we thought we had enough economic fuel. And that was that aha moment where I’m like, “Oh, these two worlds really do collide.”

Kevin Pho: So if I’m a young or mid-career physician, and I pick up your book, and I want to redefine my purpose, as you said, what kind of lessons can I come away with after reading your book? What kind of questions should I be asking myself to clarify that purpose?

Jordan Grumet: The big ideas are purpose, identity, and connections, and in the book I talk about the fact that instead of waiting until we’re financially set to think about those things, we should start thinking about them much earlier. So there’s actually a series of exercises in the book, after each chapter, which goes through ways of starting to define what you think your purpose, identity, and connections are.

When it comes to purpose, if any of the audience listeners out there have ever worked in hospice, they know there’s something called the life review. It’s a process we go through with hospice patients where the doctor, nurse, chaplain, social worker, anyone can do it, really sits a patient down, and we start talking about their lives. What had meaning for them? What did they accomplish? What didn’t they accomplish? What were those key relationships? What would they like to accomplish in whatever time they have left? This life review process actually helps them integrate their lives into the dying process. I think we should be doing those kinds of things on a yearly basis now, way before we’re on our deathbed. So the book carries you through some of those exercises with life review. Again, the real basic thing is: Imagine yourself lying in bed dying. You’re in hospice. What are those things that you regret that you didn’t have the time, energy, or courage to do? And I think that’s a great visualization to start.

There are some other exercises about identity. I love the exercise, which is just simply saying the statement “I am” over and over again and filling in the blank. When I first did this, I said, “I am a doctor,” and realized, well, that’s not really my true identity. And then I went further and said, “I am a son, a father, a spouse,” and again, that somewhat defined who I was, but not totally. After doing this for a long time, I came up with: I’m a public speaker, I’m a blogger, I’m a podcaster. Ultimately, it came out that I’m a communicator, and that was actually the identity that made me feel most secure.

When you start realizing your purpose and identity, naturally those connections come. So realizing those things, I started going to conferences where I met other bloggers and podcasters and public speakers. In my case, I was interested in personal finance, so I met other personal finance geeks, and for the first time in my life, I felt those real connections that I had never felt in medical school or hanging out in the doctors’ lounge.

Kevin Pho: On this show, we talk to a lot of physicians who have passions outside of clinical medicine, and sometimes you get pushback from physicians who are outside this world, right? They say that if you’re not taking care of patients 24/7, you’re not a, quote unquote, real doctor. Have you gotten any pushback on your journey toward personal finance and that shift away from clinical medicine?

Jordan Grumet: Certainly, even from my family, who obviously loves me and supports me. The thing about it is, I had held that physician identity so tightly around myself for so long that so did my community, so did my family members. That’s how they saw me growing up, and that’s what they expected of me too. So there wasn’t major pushback, but certainly there was a certain amount of disappointment, and “This is who we saw you as. That’s no longer who you are.”

It used to be, at the beginning of this journey, and I think you’ll connect with this idea, that 10 years ago you would tell someone you’re leaving clinical medicine, and other doctors and health care people would say, “You know, that’s such a waste. You went through all this education. Patients need you.” For better or for worse, nowadays, many of the times when I tell people, “Oh, I’ve kind of pulled away from clinical medicine,” a lot of them say, “Oh, that’s awesome,” and they get interested, and their ears perk up.

So, sad as it is, I think this is a time in medicine right now where clinicians are not feeling as dialed in as they used to, so there’s a lot more acceptance. I mean, we look at medical schools, and maybe 15 to 20 of some schools’ doctors come out of medical school and go directly into business or consulting and don’t even do a residency. So the world is changing. I guess the question is, is that for good, for better or for worse? I certainly am sad at this idea. Growing up, I bought into just about what everyone else did, that this was going to be the thing that fulfilled me in life for the rest of my life. Unfortunately, the reality just wasn’t that, and so I had to decide: Am I going to continue doing something that isn’t bringing me the joy I thought it would because of societal pressure, or am I going to do what I really want in life? And in the end, I chose what I really wanted.

Kevin Pho: Was it difficult to pitch the book? Take us into that first meeting with the publisher, and you came up with this idea, financial independence from a hospice physician’s perspective. What was it like?

Jordan Grumet: Well, certainly it’s out of the box, right? When you’re talking about publishing a book, ultimately, for better or for worse, and I’m going to open the story up for people who know nothing about publishing, ultimately the people who have a huge following are going to do really well in publishing, right? Because regardless of what they write about, there’s a lot of possibility of selling that book. If you don’t have a huge following, you either have to write about something that is really timely right now, or you have to write about something that’s really unique, that maybe you’re the only one who could write that book. So I kind of went for the third, which is: This is a really unique take on something that probably very few people could write.

So we did a book proposal. I sent the book proposal to many, many, many different publishers, and I got various different responses. But there certainly were some people who just didn’t get it, right? There were some people like, “I don’t see it. I don’t see the connection.” There were some people who embraced it but didn’t think my platform was big enough. And then there were some people who said, “Yeah, this is great. Let’s do this.” And obviously I went with the person who said that.

Kevin Pho: We’re talking to Jordan Grumet. He’s an internal medicine physician. He’s the host of the Earn and Invest podcast and is the author of the book Taking Stock: A Hospice Doctor’s Advice on Financial Independence, Building Wealth, and Living a Regret-Free Life. Jordan, so if I’m a physician in residency, an early-career physician, and I’m listening to you now, and what you’re saying is really resonating with them, other than buying your book, what are some first steps that they should take?

Jordan Grumet: I think the first steps are really doing this purpose and identity work, and let me tell you why. When I started medical school, you know what the first thing I did was on my first day of medical school? I volunteered in the hospital hospice program. I became a volunteer. This was my life telling me what I should do for a living, and I ignored it and went into general internal medicine because it sounded more exciting, etc. I only came back to hospice once I was burned out and really had felt that my feelings about medicine changed.

If I had done some of this purpose and identity work at the beginning of my career, I might have gone into hospice right away. And you know what? I probably wouldn’t have made as much money, right? Hospice is not a high-paying medical career. But I would have had a much greater longevity at my job. And so I wouldn’t have retired early, but I probably would have loved my job a lot more. It took me into my 40s to then come back and do that important work to realize that hospice was the thing in medicine that had real purpose for me. What if I had figured that out coming out of residency? I mean, I could have had a much more enjoyable career. I probably wouldn’t have burned out, and I’d probably still be working full time today and have a lot less money, but I’d probably be enjoying it.

And so I think we have to start thinking about those trade-offs early. So purpose, identity, and connections: We’ve got to start really integrating those ideas, even though they’re painful and difficult. I mean, this is stressful work sometimes. I think we’ve got to start doing this before we figure out the money.

Kevin Pho: And my final question: What are some of your take-home messages and wisdom to my clinician audience?

Jordan Grumet: Be thoughtful and intentional about what you want out of this life. It’s really, really easy to go for the low-hanging fruit. It’s really easy to continue doing what you’re doing because that’s what everyone else is doing, or that inertia is carrying you forward. Take it from me, someone who takes care of the dying: Days can turn into months, and months can turn into years, years can turn into decades, and one day you can look back on your life and realize you didn’t do those things that were really important to you. Don’t come to that conclusion when you’re sitting with me on your deathbed, getting a hospice consult. Let’s get people to start thinking about these things way earlier, and then we’ll figure out our finances, and then you can build a life that really suits you.

Kevin Pho: The book is Taking Stock: A Hospice Doctor’s Advice on Financial Independence, Building Wealth, and Living a Regret-Free Life. I’ll have a link in the show notes. Jordan, it’s wonderful talking to you again, sharing your time and insight.

Jordan Grumet: Thanks. This has been a blast.

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